NICU Flashcards
Congenital CMV: imaging findings
Peri-Ventricular Calcifications
Microcephaly. lissencephaly
Congenital Syphillis: imaging findings
Long Bone Metaphysitis
Periostisis
HSV: imaging findings
Encephalitiis
Following clinical features describe what syndromes?
A. Elfin facies, irritability, and supra-valvular aortic
stenosis
B. Growth deficiency, microcephaly, developmental
delay, short palpebral fissures
C. IUGR, triangular-shaped face, clinodactyly
D. Short stature, webbed neck, pulmonic stenosis
E. Weakness, club feet, tented mouth, inadequate
respirations
A. Williams Syndrome B. FASD C. Russel Silver D. Noonans E. Congenital myotonia/myopathy
Oligo vs Polyhydraminio?
1) Esophageal atresia
2) IUGR
3) PUV
4) Renal Agenesis
1) Esophageal atresia– poly
2) IUGR –oligo
3) PUV– oligo/normal
4) Renal Agenesis– oligo
Which CHD least likely to be picked up by newborn oximetry screening ?
Unbalanced AVSD
What are the 3 shunts in fetal circulation
1. Ductus Venosus UV -> IVC 2. Foramen Ovale RA -> LA 3. Ductus Arteriosus PA -> Ao
What does newborn blood spot screen for ?
- Endocrine (congenital hypothyroidism, adrenal
hyperplasia); - Heme (Sickle cell, beta-thalassemia);
- Metabolic
(galactosemia, fatty acid, amino acid and organic acid disorders); - Cystic fibrosis
What does newborn screening consist of ?
- Hearing
- Blood spot >24h
- Bili at 24 and 48
- O2 sat for CHD at 24-36h
BPD definition
O2 dependence beyond 28days or at 36 wks post GA
BPD: indications for post natal steroids
CPS
- not recommended in 1st week of life (for prevention)
- Consider: vent-dependant, severe CLD, low dose with taper short course (7-10d)
PDA: clinical features
– Preterm: 1st – 2nd week; Term: 4-6 weeks
– Bounding pulses, initial systolic murmur LSB then
diastolic component
– CHF, tachycardia,
tachypnea, HSM, apnea, increased O2 requirements
- CXR: cardiomegaly,, pulm edema (L-R shunt)
IVH: when to screen
<1500g or <31+6
PVL: risk factors
& prognosis
Risk factors: – Twin-twin transfusion – Chorioamnionitis – Asphyxia – Severe lung disease – Hypocarbia – NEC – Postnatal dexamethasone
Prognosis:
- CP
ROP: who & when to screen
CPS
GA < 30 6/7 weeks OR
OR
Birth weight < 1250 g
At 4 weeks of age or 31 weeks corrected
ROP: risk factors
Hypotension
Prolonged ventilation
Oxygen therapy
Slow postnatal growth
ROP: treatment, what
• Laser photocoagulation (within 72hrs of Type I ROP) • Antivascular endothelial growth factor (Proven in Zone I) (Possible risk of delayed ROP) (Informed consent)
ROP: treatment, who (Indications)
Zone 1 - any stage ROP with plus disease
Zone 1 - stage 3 ROP without plus disease
Zone II - stage 2 or 3 ROP with plus disease
NEC: risk factors
- Prematurity
- ischemia (asphyxia, CHD, PDA, severe IUGR,
exchange transfusions), complication - Hirschprungs
- Infection
Early Sepsis: Maternal RFs
- GBS +
- GBS UTI
- Prev infant GBS bacteria
- ROM >18h
- Mat fever >38
HIE: Criteria for therapeutic hypothermia
Criteria A or B AND C A. Cord pH ≤ 7 or BD ≥ -16 or B. pH 7.01 – 7.15 of -10 to -16 (cord or 1 hour gas) AND Hx of acute perinatal event AND APGAR ≤ 5 at 10m or at least 10m of PPV C. Signs of moderate to severe encephalopathy
HIE therapeutic hypothermia : temperature? Duration? Timing?
33-34
72h
1st 6h, ASAP
HIE therapeutic hypothermia : complications?
hypotension, bradycardia,
coagulopathy, PPHN, Fat necrosis
HIE: MRI findings
• Basal ganglia / thalamus / PLIC
= motor + cognitive
• Watershed areas = more
cognitive than motor
HIE: benefits of cooling (CPS)
Benefits of cooling – Risk reduction 25% combined mortality & major NDD – NNT 11 to prevent 1 mortality – Risk reduction 20% NDD in survivors
HIE: prognosis based on severity (CPS)
Prognosis: – Severe: 80% morbidity – Moderate: 30-50% (CP, cognition, language, visual acuity, emotional, seizures) – Mild: usually no deficits
Erbs palsy- what nerves affected?
Upper/Mid plexus: C5-6-7
Klumpkes Palsy- what nerves affected?
Lower plexus: C8-T1
GIR formula
[ IV rate (ml/kg/day) x % dextrose] / 144
Causes of neonatal thrombocytopenia?
– Infection: bacterial, TORCH
– Neonatal alloimmune thrombocytopenia (NAIT)
– Other maternal causes: toxemia, ITP, SLE, Drugs (hydralazine, thiazides)
– Consumption: DIC, Kassabach-Merrit (hemangioma)
– Syndromes: IUGR, TAR, Fanconi’s
– Bone marrow suppression: pancytopenia, leukemia
NAIT: treatment
Severe <30: IVIG, platelets (ABO compatible, washed/Ag neg)
Moderate 30-50, no bleed: IVIG alone
